1Mohamed Cheikh,4Sami Alobaidi, 2Naji Dwid, 2Khaldoun Shikh Souk, 2Ahmed Mandurah, 2Khaled Al-Khatib, 2Ans Ahmed, 3Hani Almoallim
1Department Of Medicine, Fakeeh College For Medical Sciences, 2Doctor Soliman Fakeeh Hospital, 3Medical College, Umm Alqura University (UQU), 4Department of Medicine, University of Jeddah
Hyperuricemia is prevalent in patients with chronic kidney disease (CKD). Although it is associated with CKD incidence and progression, treating asymptomatic hyperuricemia with uric acid-lowering agents is still debatable.
Aim of Work:
Determine the rate of non-classical prescription of allopurinol in CKD patients
Settings and Design:
This was a retrospective study of adult patients prescribed allopurinol with CKD (stages 2–5) in Doctor Soliman Fakeeh Hospital (DSFH) Jeddah, Saudi Arabia, from 1/1/2016 to 1/1/2017.
Subjects and Methods:
Eligible patients were identified from the hospital’s pharmacy system and cross-referenced with the electronic health records. Demographic data, laboratory results and indication as recorded by the prescribing physician were extracted. Prescriptions with no indication were categorized based on the uric acid levels. Hyperuricemia was documented as mild (6–10 mg/dL in females and 7–13 mg/dL in males) and severe (>13mg/dL in men and >10mg/dL in women).
From the 594 identified patients, 464 (78.1%) were males. A third of prescriptions (209/594) had no indication, 43.5% of which (91/209) had no documented uric acid levels, and 16.3% (34/209) had normal levels. Including patients with undocumented indication, 64.2% (381/594) were prescribed allopurinol for hyperuricemia, 86.4% of which (329/381) had mild hyperuricemia, and only 13.6% (52/381) had severe hyperuricemia. Other indications included malignancy-related disorders (6.2%, 37/594), gouty arthritis (5.2%, 31/594), and stones of unknown aetiology (3.4%, 20/594).
The percentage of allopurinol prescription to patients with CKD without a clear indication in our centre was markedly high. This might increase the risk for side effects with no evidence-based benefits.